Antibiotic Prescribing in Dentistry Raises Concerns
Dentists issued over 2.3 million prescriptions for clindamycin last year, an antibiotic that has carried a black box warning for over four decades due to its high rate of severe complications. Clindamycin is currently the second-most commonly used antibiotic in dentistry.
"Dentists issued over 2.3 million prescriptions for clindamycin last year, an antibiotic that has carried a black box warning for over four decades due to its high rate of severe complications."
Dolores Hernandez Owens, 92, experienced severe stomach pain, nausea, appetite loss, headaches, and frequent diarrhea days after taking clindamycin for a tooth extraction. She was subsequently diagnosed with Clostridioides difficile (C. difficile), an infection known to release toxins that can damage the intestine lining. Owens later developed sepsis, internal bleeding, and severe dehydration.
Her family reported they were unaware of the direct link between C. difficile and antibiotic use.
C. difficile and Antibiotic Overprescription Risks
C. difficile infections affect approximately half a million Americans annually and are linked to nearly 30,000 deaths. Research indicates that over half of community-acquired C. difficile cases are associated with antibiotic use, with 15% stemming from dental procedures. Clindamycin is particularly associated with a high risk of C. difficile infections.
Many dentists prescribe antibiotics preventatively for healthy patients. However, studies show that 80% of these prescriptions are unnecessary.
"Research indicates that over half of community-acquired C. difficile cases are associated with antibiotic use, with 15% stemming from dental procedures."
This practice not only increases the risk of C. difficile infections but also contributes to antimicrobial resistance (AMR), which is estimated to cause 5 million deaths globally each year.
Trends and Expert Perspectives
Despite recommendations from experts and professional societies to reduce antibiotic use, especially clindamycin, in dentistry, a CIDRAP News investigation found an increase in overall antibiotic prescribing. From 2020 to 2025, dental antibiotic prescriptions rose by 6%, totaling over 27 million.
While clindamycin prescriptions decreased by 35% during the same period, it remains the second-most commonly prescribed antibiotic by dentists. Experts, including Dr. Amesh Adalja of the Johns Hopkins Center for Health Security, state that this decline is insufficient given clindamycin's life-threatening risks.
Dr. Elliot Abt, who co-authored antibiotic guidelines for the American Dental Association, expressed disappointment regarding the persistent high use of clindamycin, noting that changing practitioner behavior is a challenging and slow process.